Shimada Kazuaki, Sakamoto Yoshihiro, Sano Tsuyoshi, Kosuge Tomoo, Hiraoka Nobuyoshi
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Pancreas. 2006 Oct;33(3):233-9. doi: 10.1097/01.mpa.0000232917.78890.01.
Recent advances in diagnostic modalities have made it possible to detect small pancreatic ductal carcinoma and to increase the number of resected cases. However, the postoperative prognosis remains dismal.
Prognostic factors after pancreatectomy were retrospectively examined in 173 patients with small pancreatic ductal carcinomas (<or=40 mm), and the size threshold for defining small pancreatic cancer as an early and curable disease was investigated.
A Cox proportional hazard survival analysis indicated that no lymph node involvement and curative resection were important independent predictors of long-term survival. The incidence of lymph node metastasis was significantly lower in patients with tumor diameters of 20 mm or less (P <or= 0.001). Tumors with diameters of 15 mm or less were statistically associated with lower extension of local tumor spreading (P = 0.001) and less advanced stage (P = 0.011). The 5-year survival rate and the median survival term in patients with tumor diameters of 15 mm or less were 75% and 62 months, respectively, which were significantly better than those in patients with tumor diameter between 21 and 40 mm (P = 0.02).
A small tumor size is not always a guarantor of localized disease. However, survival after pancreatectomy is significantly favorable when the tumor diameter is 15 mm or less. A tumor diameter of 15 mm is recommended as the cutoff size as small pancreatic cancer because tumors with diameters between 16 and 20 mm should be considered comparable with tumors with diameters between 21 and 40 mm.
诊断方法的最新进展使得检测小胰腺癌并增加切除病例数成为可能。然而，术后预后仍然不佳。
对173例小胰腺癌（直径≤40mm）患者胰十二指肠切除术后的预后因素进行回顾性研究，并探讨将小胰腺癌定义为早期可治愈疾病的大小阈值。
Cox比例风险生存分析表明，无淋巴结转移和根治性切除是长期生存的重要独立预测因素。肿瘤直径20mm及以下患者的淋巴结转移发生率显著较低（P≤0.001）。直径15mm及以下的肿瘤在统计学上与局部肿瘤扩散范围较小（P = 0.001）和分期较晚（P = 0.011）相关。肿瘤直径15mm及以下患者的5年生存率和中位生存期分别为75%和62个月，显著优于肿瘤直径在21至40mm之间的患者（P = 0.02）。
肿瘤体积小并不总是意味着疾病局限。然而，当肿瘤直径≤15mm时，胰十二指肠切除术后的生存率明显更高。建议将15mm作为小胰腺癌的临界大小，因为直径在16至20mm之间的肿瘤应被视为与直径在21至40mm之间的肿瘤相当。
